Epidemiological Research: An Introduction: An Introduction PDF
Preview Epidemiological Research: An Introduction: An Introduction
Epidemiological Research O.S. Miettinen • I. Karp Epidemiological Research: An Introduction 123 O.S.Miettinen I.Karp McGillUniversity Universite´deMontre´al Universite´deMontre´al Montre´al,QC Montre´al,QC Canada Canada CornellUniversity NewYork,NY USA ISBN978-94-007-4536-0 ISBN978-94-007-4537-7(eBook) DOI10.1007/978-94-007-4537-7 SpringerDordrechtHeidelbergNewYorkLondon LibraryofCongressControlNumber:2012942327 ©SpringerScience+BusinessMediaDordrecht2012 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof thematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerptsinconnection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. 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Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Foreword ‘In my life ever since medical-school graduation half-a-century ago, I’ve had the dreamofreachingtrueunderstandingofthetheoryoftheresearchthatwouldbest servetoadvancetheknowledge-baseofmedicine,ofgenuinelyscientificmedicine.’ OlliMiettinenwrotethisayearorso agoinhisEpidemiologicalResearch:Terms and Concepts. For those who have had the privilege to witness his odyssey since the 1970s, the current book comes as both a wonderful revisit of the past and a great leap into the future. Miettinen’s text accompanying his course in the 1970satHarvardwas‘thefirstsystematicintroductiontotheoreticalepidemiology’ (Greenland) and can be viewed as the start of ‘modern epidemiology’(Morabia). But he never published it and therefore the book that you read now is the first publishedintroductionto epidemiologicalresearchby thefatherandgrandmaster ofmodernepidemiology. Epidemiological Research: An Introduction, the current book of Miettinen, in collaboration with his junior colleague Igor Karp, is a true milestone for epidemiology, but a cautionary word may be in place about the ‘introduction.’ I remember Miettinen referring to his courses as basic, but not basal. The current book,similarly,isbasic,butnotbasal.Itisintroductoryinthatitdevelopstheobjects and methods of epidemiological research from first principles, but it does so in a breathtakinglysophisticated way, alternatinglygrandand subtle in argumentation, visionaryanddown-to-earth,broadanddeep.Forthisreaderonethingisparticularly clear:Miettinen’sdiscussionisstillunparalleledinourfield,thelogicandcoherence isasspellbindingasever(andIneedtothinkabitmore,andbetter,ifandwhenI donotfullyunderstandwhathewrites). Thestructureofthisbookmustbeatreatforallepidemiologists.From‘epidemi- ology:grapplingwith the concept’through‘etiologyas a pragmatic concern’and the ‘objectof study’ to the book’score on ‘objectsdesign’and ‘methodsdesign,’ it is like travelling to familiar destinations along new roads. Although Miettinen has always stressed the importance of objects design from first principles, I think this book is the first to treat this topic systematically and somewhat extensively. AndalthoughMiettinenhaspublishedquitecomprehensivelyonthefallaciesinthe v vi Foreword design of epidemiologicalstudies and their remedies, I find his discussion of ‘the etiologicstudy’freshandsummarizedaptlyandsuccinctlyin‘epluribusunum’and ‘eunumpluribus.’ What will be the effect on the practice of epidemiologicalresearch? I have no doubt that it will be vast, but also that it will be slow to come. In the long run, his arguments will turn out to be irresistible, although most likely modified and expanded.Itisliketheeffectofepidemiologicalresearchonmedicalpractice:itis hardlyeverdirect,itnearlyalwaystakesalongtime,butintheenditmakesatrue corecontribution. Ipaytributetothefatherofmodernepidemiology,andrecommendthisvolume to assist in deep epidemiological introspection. It will benefit epidemiology and epidemiologistsgreatly. Albert Hofman, M.D., Ph.D., Professor and Chair, Department of Epidemiology, ErasmusMedicalCenter,Rotterdam,TheNetherlands. Preface Anyoneconductingepidemiologicalresearchis proneto encounterobviousmajor challengesofaconceptualnature,sometimesseeingthemtobetauntinglycomplex, at other times subtle beyond concrete grasp. But the challenges can also remain unrecognizedandtherebyunmet,onesofmajorconsequenceincluded. Even when no longer a beginner in the research, the investigator may wonder abouttheadequacyofthecopingswiththesechallenges,notablywhenconsidering howcontroversialmanyofeventhemuch-researchedsubstantiveissuesremainand, thus, how little consequence the research – his/her own and that of others too – is having in the evolution of knowledge-based societal policies about healthcare and in the advancement of public-health practices within their respective policy frameworks. The keyto attaining,andmaintaining,the conceptualunderstandingsthatform thebasisformaximallyconsequentialcareersinepidemiologicalresearchwetaketo besuitableintroductionto–andtherebytheattainmentofawholesomeoutlookin– suchresearch.To thisend,authorsof introductorytextbooksonthe researchneed to try to present basic ideas that are so obviously well-focused and so obviously tenablethattheytherebygettobe–evenwheretheyaren’tyet–commonlyagreed upon by the teachers as properly constituting the core content of an introductory courseontheresearch. In our view, an introductory course on epidemiological research should bring to focus, and give tenable answers to, such orientational, normative questions as: To what pragmatic ends should the research be conducted? What, as for both substance and form, should the population-level research be about? What should be understood to be the necessary, logical nature of those studies themselves on the principal generic types of object of study? What are the main concerns and principles in the optimization of the objects and methods of those studies? and Howshouldtheevidencefromthestudiesbetransmutedintoknowledgeaboutthe respectiveobjectsofstudy? We here make a serious effort, our first, to formulate answers to these, and related, questions for possible incorporation into teachers’ efforts to properly introduce their students to the research – specifically, as insinuated above, to vii viii Preface epidemiological research that would be maximally consequential and hence per- sonallymostgratifyingtothem,withsocietyatlargenotonlythesponsorbutalso thecorrespondingly,ifnotevenmorerichly,rewardedbeneficiaryofit. In this effort we are guided by our belief that a proper introductorycourse on epidemiologicalresearch,like its counterparton physicsforexample,conveysthe mostadvancedinsightsintothemostelementary–themostappropriatelychosento bethemostelementary–componenttopicswithintheoveralltopic;andouraimis tointroducetheminalogicalsequence,formostnaturalandeffectivestudybythe students.Acontemporaryintroductorycourseonphysicsteaches,forexample,that theformerlycommonideaofetherasaubiquitousmediumforelectricandmagnetic forces(a`laMaxwell’sequations)isnowseentohavebeenamisunderstanding;and a suitablyadvancedintroductorycourseonepidemiologicalresearchnowteaches, forexample,thatthestill-commonconceptsofcohortstudyandcase-controlstudy shouldalreadybepasse´. Thereisastory(apocryphal)aboutthephysicistNielsBohrandthephilosopher Bertrand Russell concerningtheir respective decisions notto study psychologyin preparationforacareerinit,abouttheirrespectivedecisionstostudymathematics- cum-physicsandmathematics-cum-philosophyinstead.Bohrissaidtohaverejected the psychologyoptiononthe groundthatthisfield is too easy,and Russell onthe groundthatitistoodifficult,togainmasteryof.Weareoftheviewthatpreparation foraproductiveandtherebygratifyingcareerinepidemiologicalresearch–different fromastellarcareerinquantumphysicsortheoreticalphilosophy–doesnotrequire anyextraordinarytalent.Butwealsoarekeenlyaware,fromourpersonalstruggles, that it requires much effort and – to say it again – a proper introduction and its consequentproperorientationasimportantprerequisites.Thestudentneedstomake the investment of the effort, upon us having endeavored to help the teacher to providethelatter. Muchofanintroductorycourseonepidemiologicalresearchnecessarilyisabout concepts – and the corresponding terms – germane to such research (refs. 1, 2 below). It thus likely would materially enhance the teaching, and the learning, to supplementthistextbook(oranyother,forthatmatter)byacompendiumproviding suitableintroductoryexpositionanddiscussionofthoseconceptsandterms(ref.2), forconsultationas needed.For,dwellingon theconceptsandtermsin the flowof a course like this would tend to take away from the students’ grasp of the logic underpinningthesequenceofconcepts-basedideasbeingintroduced,manyofthem quiteoriginal. References 1. Miettinen OS. Important concepts in epidemiology. In: Olsen J, SaracciR, Trichopoulos D. Teaching Epidemiology. Third edition. Oxford: Oxford University Press, 2010. 2. MiettinenOS.EpidemiologicalResearch:TermsandConcepts.Dordrecht:Springer,2011. Acknowledgements Miettinen fils – a polymath, even if thus far without the evidentiary portfolio of writings–studiedalate-versionmanuscriptofthisbook.Weaskedhimtoimagine the youngest one of his children, the only one still young enough to realistically consider, as a potential student of one of this youngster’s paternal grandfather’s fields (theory of epidemiological research, the other one being theory of meta- epidemiological clinical research) and to consider – critically! – this text as the textbook in that youngster’s introduction into this field. And we asked him to commentfromthegeneralindustrialperspectiveonwhatwewrote(sect.14.5)about epidemiologists’role in quality assurance – economic as well as medical – in the hospital-basedsegmentofhealthcare,which in Canada now absorbsabouthalfof theeverlesssustainablefiscalburdenofthecountry’spublic-healthindustry. Hedelightedus,forone,withalearnedcommentaryonintroductoryteachingof scholarlysubjectsatlargeandonhowthistextconformswiththemostnotableideas aboutit;andforanother,heprovideduswithanequallyinsightfulcommentaryon industrial quality assurance in general and on its implications for modern public- healthpractice.Andforgoodmeasure,hepermittedustoincorporatebothofthese commentariesinthisbook(Apps.4,5). We also asked Albert Hofman, of Erasmus University Medical Centre, Rotter- dam – today’s preeminent leader of teaching on all aspects of epidemiological research,fromintroductorycoursesonup,inthe ErasmusSummerProgrammein particular – to critically review a near-final draft of this book, with a view to his possiblywritingtheForewordtoit. Hofman indeed was kind enough to read the draft, and he had quite gratifying wordstosayaboutit.Whatismuchmore,hedidagreetowritetheForeword.We aremuchobligedtohim. ix
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